Wednesday, December 30, 2009

And the linked question is, what does the new year have in store for women and families who want to access professional midwifery services?

I don't have time today, on the eve of the new year, to explore these questions at any depth. But I do want to encourage anyone who is contemplating the birth of a baby to be strong and value your knowledge of pregnancy and birth as quintessential events in a woman's life; a series of events that have powerful social and personal implications in your family and community.

What does the new year have on offer for midwives?

For me, I am looking forward to:

* being 'with woman', learning to work with and share trust with the women and their families, as we prepare for birth, work in harmony with and engage with the amazing God-given natural ability of a woman to give birth and nurture her infant.

* being a part of a complex professional team that provides expert maternity care for mothers and babies who experience complication and illness in their pregnancy-birth continuum.

* being a teacher and mentor to other midwives and women who seek to understand authentic midwifery.

* being a part of the midwifery profession, working through challenges as they arise in a time of major reform by both federal and state government in the regulation of midwives.

* being a life-long learner, willing to reflect on each experience, and apply the learning to my life.

* giving love to, and receiving love from, those around me.

And, what does the new year have in store for women and families who want to access professional midwifery services?

This will be dependent on where those women live, and what they are able to access. The standard options accessible to women in most Australian cities and large towns may provide maternity services, prenatal checks, hospital bookings and medically managed births, without any understanding of promotion of health through working in harmony with the woman's own healthy natural processes.

Basic midwifery care that is matched to each woman, with the midwife being committed to being the coordinator of the whole episode of care, and personally in attendance for birth, is not widely available.

My New Year's resolution is to continue working to improve access for women to basic midwifery services that promote and protect physiologically normal birth, and support women in making appropriate decisions when the natural process may not be likely to lead to good outcomes.

Saturday, December 19, 2009

Our loving greetings this Christmas, and with a prayer for God’s blessing on you in the coming year.

Joy and Noel

[Photo: These painted plaster figures have provided our family's Christmas montage for many years now. Joseph now wears a blu-tak collar to keep his head on. The 'hay' is sugar cane mulch. This year we have added three 'Kaper Kidz' dolls, representing Granny, Grandpa, and our Poppy.]

SAFETY OF DISADVANTAGED WOMEN AND BABIES IS THREATENED BY KING’S CLOSURE OF THE ALBANY MIDWIFERY PRACTICE

King’s College Hospital has abruptly severed its contract with the Albany Midwifery Practice with no prior consultation with women – and without proper provision in place to replace the service – leaving expectant and new mothers in the lurch and anxious about receiving appropriate care.

The Albany Midwifery Practice has been shown to offer the Gold Standard of care to around 200 women in Peckham each year. It provides an outstanding service which enables women to be cared for by a midwife they know. Women who use this service are enabled to make their own decisions about the place to birth. It is unacceptable to withdraw such a safe and much needed service from the poorest women in society.

The Albany Midwives’ care has provided women-centred care for women from deeply disadvantaged backgrounds for twelve years. Peckham ranks as the fourteenth most deprived district of 354 districts in England.

The statistics speak for themselves:Albany Midwifery Practice [King’s College Hospital]

The Practice offers women a chance to have care from a midwife they know and to have their full attention throughout labour. Between 40% and 50% of these women choose to have their babies at home.

‘I feel blessed and truly privileged to have had the Albany midwives care for me during my pregnancy. They are an amazing group who go out of their way to treat their women (and our families) with the care and consideration we deserve during our pregnancies. I know for a fact that I wouldn’t have had the confidence to resist an instrumental delivery if I had not been so well informed and supported during my pregnancy and labour. I also know that I wouldn’t be the confident mother I am today if I had not met the Albany midwives. They have made a profound impact on my life and if I am blessed with a further pregnancy I wouldn’t hesitate in trusting them again with my care. ‘(Serra)

The Association for Improvements in the Maternity Services (AIMS) is concerned that these women may well find themselves in hospital where one-to-one care in labour is not offered. The Health Care Commission Report showed that over a third of women in King’s were left alone in labour or shortly after birth and were frightened. Already the UK maternal death statistics show that women in these disadvantaged groups are more than six times more likely to die in childbirth. All these deaths took place in hospital.

In order to justify the suspension of the service King’s College Hospital appears to be trying to make the case that the service is unsafe. They have looked at a selected number of Albany cases admitted to their Special Care Baby Unit and asked the Centre for Maternal and Child Enquiries (CMACE) to investigate.

We understand, however, that they have not examined the deaths of babies that have occurred in the King’s unit nor the babies from there who were also admitted to the Special Care Baby Unit. Nor do we have what AIMS believes is crucial data – comparative rates of mental illness after childbirth, where we believe the Albany is likely to have far better results.

This action mirrors the attempt, in 1985, by obstetricians at The London Hospital to strike off Wendy Savage, a consultant obstetrician, who provided the kind of care that women wanted and who also had a far lower caesarean section rate than her colleagues.

‘The suspension of one of the Albany Midwives and cessation of their practice reminds me of my own suspension in 1985. The same intolerance to alternative ways of providing maternity care, despite comparable outcomes for the babies and lower Caesarean section rates, the same technique of selecting cases with adverse outcomes without looking at the overall care, and the same refusal to look at what the women themselves want. I hope that King’s will listen to those who consider this suspension an outrage and reinstate the midwife and the service immediately.’Wendy Savage MBBCh MSc HonDSc FRCOG

King’s has claimed that it has suspended the service because it has the safety of the mothers and babies at heart. The Albany Midwifery Practice has long been acknowledged as a centre of excellence, yet King’s management is unwilling to provide this standard of care for more women, and instead is trying to remove it so that women have no choice but to accept medicalised care.

The reality is that King’s College Hospital’s action in withdrawing the Albany Contract has put women and babies at increased risk.

AIMS demands that King’s College Hospital releases the CMACE Report and the comparable statistics for its own consultant unit so that data from both services can be examined objectively.

Saturday, December 05, 2009

I drove to the home for the postnatal visit in the late morning. The baby had been born at home two nights previous. It had been a quick, powerful birth. The mother told me she knew her labour had commenced when she was putting her children to bed because she felt the urgency to settle them, and get on with her work of birth without distraction. She asked me to come without delay. I arrived at about 10pm. Labour was strong. The baby was born at 10.30, and welcomed lovingly into his mother's arms. The placenta came away soon after.

The mother greeted me at the door. She had obviously been crying. "Are you alright?" I asked."The rabbit has died", she explained, "and I think I am having my third day blues."

We sat down together, had a cup of tea, and chatted. The baby was perfect. He was sleeping in his bassinet in his parents' bedroom. Feeding well at his mother's breast, skin colour good, passing urine and meconium - what more could a midwife want? Mother was strong, and her physical recovery from birth was progressing normally.

Our chat was interrupted by an urgent cry of pain from the toddler. Her little toe had been jammed in the door accidentally by her older brother. The mother's attention was diverted as she soothed her little one, the way mothers do.

A mother expects these minor crises to present unexpectedly, and she deals with them. It's part of being a mother. Mothers who choose homebirth, and who intentionally maintain their strong attachments with older babies in the early postnatal days demonstrate strength and courage in their mothering. Complexities of life don't somehow disappear because a new baby has been welcomed into a family.

I have been priviliged to attend this family for the births of several of their children. That continuity of care, not only through a pregnancy, but also in the continuum of a family's development, is precious. This is 'village' midwifery.

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Retired from clinical practice

I have retired. Joy JohnstonMobile: 0411190448

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About me

I have been a midwife since 1973, and have practised independently, attending births in homes since 1993.

My four children, born after I qualified as a midwife, taught me that the medical model of care was not suitable for a well woman. The first three, born in a hospital in Lansing, Michigan, taught me that I could push boundaries. The fourth, born at a birth centre in Melbourne Australia, opened up new possibilities, and new philosophies. The babies themselves taught me about birthing and breastfeeding. My first grand-daughter, born into my hands, has brought to my life and loving a wonderful new dimension. The birth of each subsequent grand-child has been a precious time for me.

I learn more from every woman who takes me into her life for the birth of her child. I learn more from each wonderful baby as she or he enters our world.

It is not easy to practise as an independent midwife in Melbourne. Women do not, as a rule, question the care that is available through our health system. Women giving birth are usually submissive to the dominant medical system. Options are not well understood, and not widely available.

Women who choose midwife care are discriminated against financially. Whereas free hospitalisation and subsidised visits to the doctor are available to all, care by a known midwife is usually expensive, except in isolated public hospital programs.

In recent years I have been less able to ignore ageing, and I have realised that I need to write my stories, and share my professional knowledge so that it is not lost when I am no longer able to practise.

Thankyou for visiting my blog. I hope you will find it informative and useful. Please leave a comment or contact me joy@aitex.com.au